A New Health System for An Aging Society
By Michael Hodin
Just checking, Messrs. Dimon, Buffett and Bezos. Now that it’s been a few months since your much-heralded and welcome Amazon, Berkshire Hathaway, and JPMorgan Chase announcement to provide your employees with healthcare, and effectively begin the process of transforming through a best practice the delivery of care, how is this, really, to be done?
So, the question that nobody is asking but will determine its fate is whether a sustainable healthcare system can be created for an aging society? We appreciate it’s only been 6 months since your announcement, but the need is so great. Well, anything to report yet?
We are, in fact, in an era defined by the irreversible consequences of a world with more old than young, as birthrates fall and lives extend to lengths that, for the history of humankind, have been unimaginable. Here in the U.S., which we understand is your initial focus, an incredible 78 million Baby Boomers are becoming “seniors,” and the 80+ demographic is the fastest growing over the next decades. The demographic forces are similar everywhere. Societies in Japan, much of Europe, and South Korea are rapidly touching close to 40% of their populations over 60. Shortly, China will have as many over 80 as our entire American population today. In the industrial democracies, there are already more over 60 than under 15; globally we reach that point in 2020, when the WHO will declare 2020–30 The Decade of Healthy Aging.
The implications for health systems begin with simple economics. As we live longer, we increase the demand for healthcare, which costs lots of money. And because the aging of society is baked in well past mid-century, any disruption of healthcare must take it as its fundamental premise. Put another way, institutions and public policies invented in the 20th century are wholly unworkable in the context of 21st century age demographics.
For those who like the word “sustainability,” there ain’t anything more unsustainable than our 20th century health care models.
Viewing healthcare disruption through the lens of aging brings priorities into focus, therefore, that Messrs. Buffet, Dimon and Bezos need to build into their planning:
First, we must re-imagine what it means to age — and disrupt the supply-and-demand imbalance that is currently crippling our systems. This re-imagining begins with embracing the notion of healthy aging and shedding the old notions of retirement, disability, dependency that are the hallmarks of 20th century aging.
The World Health Organization offers a useful framework: healthy aging isn’t the absence of disease, but the presence of functional ability. The WHO’s contention is no semantic quibble, but an entirely new understanding about what it means to live a century-long life. This goal of healthy aging and functional ability cannot be stressed enough. For any healthcare entity to succeed in the 21st century, its goal cannot just be treating disease. It must be enabling wellness — and in preempting the kinds of health problems that particularly afflict older adults and, in the process, burden healthcare systems. The conditions of aging are especially challenging. Heart failure is a serious and misunderstood health need, dramatically targeting our aging population. And, of course, vision and hearing loss, urological health, as well as muscle, bone, oral and skin deterioration. These conditions of aging — oh well, he’s just old — can be re-imagined for an active aging that will have impact on quality of life, cost of care, and, critically, economic growth itself. Enable just another 10% of today’s presumed retirees to keep working and you’ve added productivity not unlike opening economies to women a few years back.
Second, make sure we account for elder caregiving — the act of caring for an older parent, spouse, or other loved one. An incredible 61% of U.S. workers over the age of 48 report that, because of elder caregiving duties, they either arrive at work late, leave early, spend part of their day managing care, or decline opportunities for promotion. Moreover, people who act as elder caregivers — your employees today, by the way — are too busy and preoccupied to care for their own health. According to one study, those who care for an elder report chronic conditions at nearly twice the rate of those who do not.
Worse, elder caregiving remains an invisible problem. Employees hide their caregiving responsibilities at work because they don’t want to be seen as distracted or under-performing, and employers, left unaware, can’t provide support and resources to help out. Looking for a source that will solve the mystery of productivity — look no further than the hidden impact of elder caregiving on your workforce.
Third, if you truly want to disrupt, then go to the heart of today’s healthcare cost issues — hospitals and physician visits. Your instincts on the impact innovative technology will have on monitoring and delivery are already showing transformation in today’s marketplace, where remote care monitoring is starting to be used: for example, for reductions in hospital readmissions up to 75% and roughly $150,000 in savings per patient per year, or for the 66% reduction in hospital admissions for monitored patients with congestive heart failure. Remote care is becoming the new standard of care, and your application to your employees and their families will grow this for all of us.
By mid-century, there will be 2 billion of us over 60 on the planet. Disrupting healthcare must no longer be just about health care, but about economic growth, worker productivity, and quality of life as we age. Good luck! We’re all still rooting for you as we look for action.
